Monetary incentives would offset the downside of letting strangers perforate your flesh with sharp instruments. Someone who provides marrow has to go through a longer and less enjoyable process than supplying blood or sperm.
Typically, marrow donors have to get injections for five straight days. They then undergo a blood-collection process that takes three hours and sometimes has to be repeated.
Often, donors are anesthetized so a needle can be inserted into a hip bone. In that case, says the American Society of Clinical Oncology, they may need a week to fully recover.
Donating is not an excruciating experience, but it's unpleasant and time-consuming enough that about the only people who do it are those with a strong motive (say, a friend or relative in need).
One result is that one of every three volunteers matched to a recipient backs out, leaving the patient high and dry. According to the Institute for Justice, which is handling the case, 1,000 people die each year for lack of a suitable marrow donor.
If Americans could be paid for bone marrow, more would step forward. Nobel Prize-winning economist Gary Becker of the University of Chicago, in a 2007 paper written with Julio Jorge Elias of the State University of New York at Buffalo, figured the kidney shortage could be eliminated for $15,000 per organ.
That's not much, considering that it means the difference between living and dying. It would add only 10 percent to the total cost of a transplant.
The fee would be much lower for bone marrow, simply because the donor can quickly regenerate what is lost. In the California lawsuit, the plaintiffs only want to be able to try offering compensation in the form of a scholarship, a housing allowance or a gift to a designated charity.
There is certainly no better option on the horizon. The benevolence of our fellow citizens can be striking. But it's not something to bet your life on.
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